Child Health in Ethiopia

Child Health In Ethiopia

• Developing countries account for 80% of child deaths worldwide.
• Preventable deaths account for 60% of child deaths in low-income areas.
• Morbidity causes include acute respiratory infections, diarrhoeal diseases, malaria, and neonatal problems like tetanus.
• Substance abuse and child labor are emerging health concerns.
• In Ethiopia, 44% of the population is under 15 years old.
• Ethiopia's infant mortality rate stands at 96.8 per 1000 live births.
• Low birth weight deliveries occur in 16% of births.
• In Ethiopia, 49 out of 1000 live births result in infant deaths.
• Common causes of child morbidity and mortality are protein-energy malnutrition (PEM), anemia, vitamin A deficiency, acute respiratory infections (ARI), malaria, and vaccine-preventable diseases.
• 52% and 47% of children under five are stunted and underweight, respectively.
• Wasting affects 11% of children.
• Bitot's spot and night blindness prevalence is 5% and 7% in different regions.
• Colostrum avoidance occurs in 60% of births, while 70% of neonates are breastfed within 24 hours.
• Delayed treatment-seeking for ARI contributes to deaths.
• HIV/AIDS affects maternal and child health, with 400,000 children newly infected every year.
• In Ethiopia, 200,000 children lived with HIV/AIDS, and 1.2 million were orphans according to 2001 estimates.
• Prevention of mother-to-child transmission of HIV (PMTCT) programs are in their early stages.
• Expanded Programme on Immunization (EPI), ARI case management, and diarrheal disease control are health interventions implemented in Ethiopia.
• EPI launched in 1980 aimed for 10% annual coverage increase to reach 100% by 1990, but failed.
• EPI faced hurdles like poor health infrastructure, low manpower, high staff turnover, and funding decline.
• National coverage for BCG, DPT3, and measles was 63%, 51%, and 40% in 2001.
• Integrated Management of Childhood Illnesses (IMCI), launched in 1998, integrates child healthcare aspects.
• IMCI components: health worker skills, health system improvements, and family/community practices.

Immunization

• Vaccination involves administering a vaccine or toxoid to prevent disease.

• Immunization artificially induces immunity.

• Immunization can be active or passive.

• Active immunization stimulates the immune system to produce antibodies and a cellular immune response.

• Passive immunization offers temporary protection with exogenous or maternal antibodies.

• Maternal antibodies and immature immune responses in infants under four months can hinder immunization.

• Measles vaccine administered at 9 months aims to mitigate the impact of maternal antibodies.

• Oral vaccines induce mucosal secretary IgA (e.g., OPV).

• Inappropriate vaccine administration can reduce immune responses.

• Live attenuated vaccines offer longer immunity from a single dose than inactivated ones.

• Genetic variations affect individual vaccine responses.

• Vaccine potency, especially for live attenuated vaccines, needs cold chain maintenance determining EPI program quality.

• Ethiopia's EPI, launched in 1980, targeted 6 diseases for complete coverage by 1990, but current coverage is less than 30% due to logistical and managerial issues.

• Routine vaccines for children are available in different forms and require specific temperature ranges for storage.

• Oral polio and freeze-dried measles vaccines need -15°C to -25°C storage.

• DPT, freeze-dried BCG, and tetanus toxoid need 2°C to 8°C storage.

• Injection safety demands that vaccines are not a health threat.

• Unsafe injections stem from reuse of syringes/needles, inadequate supplies, and improper disposal.

• Single sterile syringes/needles should be used for each vaccine dose.

• AD syringes preferred with safety boxes for disposal.

• Incinerate full safety boxes, remove residue, and avoid random dumping.

• Vaccination strategies adapt based on the local context.

• Primary Infant Immunization Schedule (Static Health Services):

  • Following birth: OPV; BCG.
  • At 6 weeks: OPV, DPT; BCG (if it was not administerd at birth).
  • At 10 weeks: OPV, DPT.
  • At 14 weeks: OPV, DPT.
  • At 9 months: Measles, Vitamin A.

• Children under 6 months should not receive the measles vaccine/Vit A

• At 6-11 months, give 100,000 IU of Vit A, and give 200,000 IU for every 12-59 months old infant

  • A child's immunization details must be recorded on an immunization card

• Here is schedule for children under 5 who have not been vaccinated before:

  • 1st Visit: DPT, OPV, Mantoux test, BCG (if test is negative in 3 days)
  • 2nd Visit (1 month after): DPT, OPV
  • 3rd Visit (1 month after): DPT, OPV, Measles (if not exposed)
  • 4th Visit (1 year later): DPT, OPV
  • 5th Visit (4 years after): Adult type

• Mobile outreach services cover people within 20 km of health facilities.

• Mass campaigns include National Immunization Days (NIDs) for polio and measles.

• Here are the Side effects of vaccines

  • For the BCG vaccine you must be aware of these side effects
    • The Koch phenomenon is a self-limiting acute inflammatory reaction 4 days after.
    • Indolent ulcer that persist for 12 weeks post vaccine, or an ulcer more than 10mm usually from deep injection or infection
    • Deep abscess that occurs at or around the injection or other lymphnodes because of subcutaneous injections
    • Disseminated BCG can occur in 1 per million vaccines in mainly immunocompromised hosts.
  • OPV: paralytic polio from vaccine strain poliovirus DPT Major Side effects: - Superficial injection can cause injection site abscess a week later.
    • Encephalopathy ( 0.3 – 3/100,000 vaccines)

• Convulsion (0.3 – 90/100,000) - Shock, Hypotonia, hyporesponsiveness (0.5 – 30/100,000)

  • Brain damage (0.2 – 0.6/100,000) Measles, low grade fever irritability and allergic reactions. can also occur
  • Encephalopathy (0.1) - Convulsions (0.02 – 100)
  • Sub acute sclerosing panencephalitis (0.01 – 0.05)

• There are times where the risk outweighs the benefits

• These are general contraindications for vaccinations

• Anaphylaxis

• Severely ill patients

• Live-attenuated vaccines for severely immunosupressed patient (except measles) Not contraindications

• Moderate fever or local reaction, Mild acute illness, Prematurity or malnutrition, or an allergic reaction aren't contraindications

  • Symptomatic AIDS for the BCG - Severely immunocompromised patients

• diarrhea, in that case a second dose must happen 4 weeks later. DPT:

• Encephalopathy within 7 days of Previous dose not attributable to another cause If someone has seizures, defer until the seizures are controlled - if the temperature is greater than 40.5 in the prior dose it must be monitored

• Collages or shock like state, convulsion within 3 days of does or persistent crying should also be a concern - also gillian - Barrie must be closely watched after the dose

• Family history of seizures, well controlled epilepsy, febrile convulsions are not contraindications

• For special cases, if there's a large disease outbreak or special circumstances for the measles, give the vaccines

• Vaccinate all children 6 months. Use Vitamin A prior if not Meningococcal vaccine

• Affects classical people between 2-3 years old If the attack rate is high among more than 30 year olds, vaccinate everyone.

Growth and Development

• It allows you to monitor and track a child's progress,
• Understand the effects of biological effects and environmental factors, and
• Understand how parents conceptualize development
• The process in size and function of a living organism
• Genetic and environmental factors control child growth with hormones such as: growth hormone, somatomedines, insulin, thyroid hormone, and sex hormones.
• Proper nutrition is needed for body functions
• One must assess growth using tools such as; growth charts, measurements: weight vs age an height
• Using charts for correct measurements is essential
• Midterm measurements need to be compared to that year groups, and normal measurements occur between the 5th and 95 percentile.
• Children under 5 are measured differently than older children Weight, measure with calibrated measurements Height, measure supine under two or over three years of age.
• Head volume is helpful under 3 to see how is developing, measure with a non stretchable tap Developmental Tests:
• To look at the gross and fine movements in a child, for a potential development delay
• As well as mental and social, watch for general alertness.and language development

Nutrition

• Provision of required nutrients for energy and functions like: growth, reproduction, defence, repair, etc., if impaired leads to malnutrition. Types: Undernutrition- lack of nutrients PEM- lack of protein and energy. Micronutrient deficiency- Lack vit/min
• Causes stunting, 20-40% are underweight
• Malnutrition is the peak age for mortality in 14-24 month period
• 27% have a vitamin deficiency and 17% is vitamin A deficiency, also anemia and iodine Multifactorial reasons for malnutrition
• Improper diet, or contamination can occur
• Poor breastfeeding and diet
• Exclusive feeds are important because colostrum protects. Complementary feeds are good until 24 mon It can be combatted with:
• Hygiene prep
• Energy.protein
• Easy to digest
• Prevent with; safe measures during preg
• 45% hiv moms. transfer 34-55, don't, which is great news Recommend breastfeeds till 24 if possible If not, the water is important 1: to maintain a 99 5 level 2: stigma against non breastfeeding 3: financial
• So use with other sources like
• Boiled milk 1, 2 parts, then undiluted. Also must assess diet with a
• Clinical with scans
• Anthropometry measures It is used for longer term but to not detect certain problems So the methods are Weight measure, length, with an upper arm. Use low or standard measurements. Weight or stature, so in the legs, bone, fat, protein Also, test with glucose samples in the blood There's Gomez with Weight = pt normal x